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ACA Learning Series Massachusetts Health Care Training Forum
January 2015
Massachusetts ACA Learning Series
The purpose of this ACA Learning Series is to educate
staff who currently assist Health Connector,
MassHealth and Health Safety Net (HSN) members at
Massachusetts hospitals, health centers and
community-based organizations
• Introduce key concepts and create awareness
• Deliver important, detailed information that will prepare you
for assisting populations you serve
• Provide you with specific information and training to help
populations obtain coverage
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• Open Enrollment Update
• Income Guide
• Sample Notices
• Payment Information
• Frequently Asked Questions
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Agenda
Open Enrollment Update
This year’s Open Enrollment period is from November 15,
2014 – February 15, 2015
•Individuals enrolled in the following programs WILL need to
submit a new application during open enrollment.
This includes:
• Qualified Health Plans (QHPs) with coverage ending 12/31/14
• Commonwealth Care (CommCare)
• Medical Security Program (MSP)
• Temporary MassHealth Coverage
• Temporary MassHealth Limited
• Temporary Small Business Employee Premium Assistance
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Open Enrollment 2014-2015:
Overview
• Current MassHealth members who are receiving benefits
through the following MassHealth programs DO NOT need to
submit a new application during the Open Enrollment period:
• MassHealth Standard
• CarePlus
• Family Assistance
• Limited
• Health Safety Net
• Children’s Medical Security Plan
• CommonHealth
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Open Enrollment 2014-2015:
Overview (cont’d)
Currently Enrolled Populations
Count
(as of
9/8/2014)
End Date of
Existing
Coverage
If eligible for Connector
Coverage, Deadline to
Apply and Select a Plan
(to avoid gap in
coverage)
If eligible for Connector
Coverage, Payment Due
Date
Qualified Health Plan (QHP) ~33K 12/31/2014 12/23/2014 12/23/2014
Commonwealth Care and
Network Health Extend (formerly
MSP)
~100K 1/31/2015 1/23/2015 1/23/2015*
MassHealth Temporary Coverage
– Wave 1
~100K 1/15/2015 12/23/2014 1/23/2015*
MassHealth Temporary Coverage
– Wave 2
~100K 1/31/2015 1/23/2015 1/23/2015*
MassHealth Temporary Coverage
– Wave 3
~100K 2/15/2015 2/15/2015 2/23/2015*
Qualified Dental Plan/Small
Group Medical/ Small Group
Dental
~9K Varies by
anniversary date
Varies by anniversary
date
Varies by anniversary date
*Members determined eligible for MassHealth and some subsidized QHP coverage will not need to submit payment
What we need to accomplish during the 2015 Open Enrollment period: • Outreach over 400,000 residents about open enrollment and applying for ACA-compliant coverage
• Assist all qualified persons in applying, shopping for and enrolling in a plan to avoid a gap in coverage
Open Enrollment 2014-2015:
Transitioning Populations
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Daily & Weekly Dashboards
The Governor’s office
distributes daily and
weekly enrollment
dashboards which
includes:
• 180,936 transitioning members program determined (as of 1/2/15)
• applications submitted
• members enrolled
To see these reports, go to: https://www.mahealthconnector.
org/about/pressroom/open-
enrollment-2015-dashboards 8
Enrollment Events
During Open Enrollment the Health Connector and MassHealth
sponsored four Open Enrollment Events. These events were held
in Springfield, Boston, Worcester and Fall River.
Additional in-person assistance will be taking place at the Health
Connector Call center in Boston on January 20-23.
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Income Guide
Income Guide
The income portion of the application is critical to
getting the correct program determination for the
consumer. An income guide was created to go over
how to properly answer the questions.
The next slides highlight a few common questions that
have been troublesome for consumers:
•Projected Income
•Current Income
•Entering Social Security Benefits
•Entering in Deductions
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Projected Income
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Provide the individual’s
projected annual
income for 2015 on
this line.
Differentiating projected and current income is important as this information
is being collected for both MassHealth and Health Connector programs.
Some consumers are entering the wrong information in these fields and
getting an incorrect eligibility determination as a result
Current Income
After entering the projected income for the year of 2015, the next
question is about what the consumer’s current income is
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This should be answered
for the month in which the
application is completed.
If the consumer has any
current income they
should click “Yes.”
Social Security Benefits
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Some Assisters have commented that question can be confusing.
Remember Social Security Benefits should be entered – SSI is a different
type of benefit
Note: There is no change to how social security is counted (SSDI/RSDI has always
been countable and SSI has never been countable). When assisting consumers, only
look at their Social Security check, rather than anything they get from SSI
Entering Deductions
• Certain deductions can lower the consumers income that is
used to calculate their eligibility and make a correct program
determination
• It is important that Assisters only include deductions that are
allowed to be deducted on federal income tax returns. These
deductions factor into building a consumers Modified
Adjusted Gross Income or MAGI
• The next few slides list acceptable deductions
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Remember: When assisting a consumer, only include
deductions that are allowed to be deducted on their federal
income tax return. They are: • Self-employment business expenses (Most deductions for self-employed business expenses are included
in net income (the profit once business expenses are paid) but additional deductions can be taken for
the deductible part of self-employment tax, self-employed SEP, SIMPLE, and qualified plans, and self-
employed health insurance deductions.
• Portion of interest on student loans – May be able to deduct a portion of the interest they expect to pay
on a qualified student loan. Box 1 of the 1098-E Form shows the interest paid for the prior year, which
may be helpful in projecting student loan interest that will be paid during the year
• Alimony paid
• IRA deduction
• Tuition and fees
• Health savings account contributions
• Penalties on early withdrawal of savings
• Certain business expenses of performing artists, reservists, and fee-basis government officials
• Moving expenses related to a job change
• Domestic Production Activities deduction
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Entering Deductions (cont’d)
Entering Deductions (cont’d)
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Sample Notices
Notices
• Health Connector and MassHealth notices have been
redesigned to be compliant with ACA standards
• They have been field tested within the community with real
consumers and consumer advocates
• These notices are being sent to consumers and those with
an ARD on file
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MassHealth Sample Approval Notice
Each individual in a family
receives a MassHealth
approval notice.
This approval notice
includes:
• Explanation of benefits
• How to access benefits
• Appeal Information
• Hearing Request Form
• Babel
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Approval Notice
for MassHealth
Standard Name
Address
Name
MassHealth Premium Assistance Program
• Do you have health insurance from a job?
MassHealth members who have health insurance from a job may be able to get help paying for part of their premium. This health insurance must meet certain rules.
For more information contact the MassHealth Premium Assistance Unit at 1-800-862-4840 (TTY: 617-886-8102 for people who are deaf, hard of hearing, or speech disabled)
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MassHealth Sample Provisional
Approval Notice
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If we are unable to verify an applicant’s information, they may be provisionally approved for a benefit based on their self-attested information.
• They will receive a provisional eligibility notice and a Request for Information (RFI).
• This provisional approval notice has all the same information as an approval notice, but on the first page includes the two paragraphs below.
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MassHealth Sample Denial Notice
Each individual that
applies and who is not
eligible for MassHealth
receive a denial notice
This denial notice
includes:
•Denial reason and
regulatory citation
•Appeal Information
•Hearing Request Form
•Babel
Denial Notice for
being over
income
Name
Address
Name
Health Connector Approval Notice
This eligibility notice
is up to 9 pages and
includes:
• Eligibility for each
member
• Explanation of
ConnectorCare &
Premium Tax Credits
• Appeal Information
• Hearing Request Form
• Babel
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Eligibility Notice for
ConnectorCare and QHP with
APTCs
Health Connector Denial Notice
This eligibility
notice is up to 5
pages and includes:
• States member is not
eligible for Health
Connector and may be
eligible for MassHealth
• Appeal Information
• Hearing Request Form
• Babel
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Denial Notice for
ConnectorCare and QHP with
APTCs
MassHealth and Health Connector
Request for Information (RFI)
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For those who need to provide additional verifications, their households will receive a shared Request for Information (RFI) notice from MassHealth and the Health Connector.
This notice includes:
• A list of each individual in the household and what verifications they must provide
• Date the information must be received
• A list of acceptable verification documents
• Babel
Name
Address
Name
Health Connector
Payment Tips
Online Payments Tips
• The getting started guide on Mahealthconnector.org has a lot of helpful,
detailed information on how to make payments for Health Connector
plans
• Payments are due on the 23rd of each month for coverage for the
following month (ex. Payment due Jan. 23 for Feb. 1 coverage)
• When using the online payment feature (available at
https://payment.mahealthconnector.org) be sure to enter consumer’s
information (like name, date of birth, and address) the same way as it
was entered on the application, but do not include middle names, initials
or any suffix
• If there is any problem processing a payment, the consumer will receive
an email, a phone call, or a letter in the mail in order to resolve the issue
• Include an email address when making an online payment, as email is
the fastest way for us to communicate if there is a problem with payment
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Making an Online Payment
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After a consumer has submitted an application, they
will get this pop up window. Click on one of the two
links.
Making an Online Payment (cont’d)
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Then go back to the application and make note of the
Subscriber ID and the total premium amount. Using
this information follow the steps in making an online
payment. There are detailed steps on the Getting
Started page of Mahealthconnector.org.
Tip: It is helpful to use two
separate tabs in a browser or two
separate windows. If you use the
browser’s back button to go back
and forth between payment
screens and eligibility screens,
they will lose the information on
the payment screen.
Making a Payment by Mail
• Fill out the check or money order completely and sign it
• Make the check or money order payable to MA Health
Connector
• If a consumer has a bill from the Health Connector include
the detachable payment coupon with the payment
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Making a Payment with No Bill
• Make sure to have the exact amount of the premium
• Write the 12-digit Member ID on the memo field of the check or
money order
• When logged into your Health Connector account
• Go to My Enrollments → Enrollment Details
• This is the number to the left of the name
• Use the Member ID number of the primary Subscriber on the account
(this is the person identified as “SELF”)
• If a consumer doesn’t have either a Billing Account Number or
Member ID – write the Social Security number of the primary
member, if they have one, on the front of the check or money order
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Other Tips on Payment by Mail
Be sure that:
• The check has the name of the primary Subscriber on it. If a relative or
friend is paying for the primary account holder (and the name on the
check is not the primary account holder), write the name of the primary
Subscriber on the check
• The check has the primary Subscriber’s address on it. If the address on
the check is not the current address, write the correct current
address on the front of the check
• If they have both Health and Dental coverage from the Health Connector,
they will need to send a separate payment for each plan
Mail check or money order to:
MA Health Connector
PO Box 970063
Boston, MA 02297-0063
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Making Health Connector Payments
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• Helpful fact sheet on how to
make Health Connector
Payments (available at the
resource table)
Frequently Asked Questions
How Come…
…this married couple received an eligibility
determination for a QHP with NO help in paying for
health insurance?
• Scenario: Married couple answered that they do not file
taxes jointly
• Reminder: In order to receive Premium Tax Credits a couple
must file jointly
• Tip: The couple may not have filed jointly in the past, but if
they agree to filing jointly in the future, they should answer
YES and may be determined eligible for state and federal
subsidies
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How Come…
…the consumer and their household are not allowed to
shop for a plan?
• Scenario: The applicants were determined eligible for help
with paying for health insurance, but in different QHP
programs. The system is not allowing them to shop
• Families that reside together, but belong to different tax filing units. After
program determination, if certain members are eligible for MassHealth while
others are eligible for QHPs, the system does not currently allow the QHP
members to shop
• Multiple QHP Households. These are people who reside together, file taxes
together but have been program determined eligible for different types of
QHPs as a result of Indian status or other Minimum Essential Coverage (MEC)
the system does not currently allow these members to shop
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How Can…
…these mixed households get health insurance
coverage?
• These Mixed QHP Benefit Household Individuals should
contact the Health Connector Customer Service Center to be
placed in provisional coverage using the existing escalations
process. Only customers who contact the call center, who
are confirmed as Mixed QHP Benefit Household individuals
that are not able to shop and enroll in a QHP and who do not
have coverage for 1/1 will be placed into this coverage.
Depending on the individual’s eligibility determination, there
may be a premium required for this coverage
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How Come…
…we answered that the consumer has access to
employer sponsored insurance, but they were
determined eligible for ConnectorCare?
• These members are not really eligible for tax credits if they
have affordable ESI, but if all they were looking for was HSN
and they are determined eligible for HSN, then they do not
have to worry about losing the HSN by not enrolling in the
accompanying QHP. We discourage consumers from enrolling
in a Health Connector QHP since once we fix the problem, they
may not be able to get back into their employer plan. For those
consumers that insist on enrolling in a QHP, it is recommended
they set their tax credit to zero to avoid tax penalties
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Where Do I…
…Submit ID Proofing verifications?
ID Proofing documents need to be submitted:
• 133 Portland St Boston, MA (or by fax to 617-887-8745) for the
fastest processing. Once received, these documents are processed
within 48 hours
• If the same documents must be sent to Taunton for other verifications,
you must also separately send copies of any documents used for IDP
verification to 133 Portland Street to ensure the fastest processing
possible
• Consumers do not need to wait to hear back from us to confirm the
account has been unlocked; it will be unlocked faster than they hear
back from us. They should check once a day for the 2-3 days after they
fax us their information to see if they have already been unlocked
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Where Do I…
…Submit other verifications?
• You can either mail or fax a copy of the requested
verification document(s) below showing your information.
Please follow the instructions in any notice your receive
• Fax:
857-323-8300
• Mail:
Health Insurance Processing Center
P.O. Box 4405
Taunton, MA 02780
• Tip: You can still enroll in MassHealth coverage or Health Connector
plans while verifications are being processed, which can take up to 90
days. You will get a letter from either MassHealth or the Health
Connector with any next steps you need to take within 90 days of
completing your application
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What if…
…the consumer received coverage in 2014 for temporary
MassHealth coverage, Commonwealth Care, or MSP how
should the consumer complete:
Do you currently have health insurance?
Indicate No
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What if…
…the consumer is a naturalized citizen but does not
know their Alien number or Naturalization Certificate
number?
• If they do not know their Alien Number or Naturalization Certificate
number the can:
• Check “I don’t know” AND
• Enter seven 9s in the Citizenship Number field 9999999
• More information on entering immigration can be found in the
Immigration Toolkit at: https://betterhealthconnector.com/immigration-
document-types
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What is Naturalized Citizenship?
• Naturalization is the process by which U.S. citizenship is granted to a foreign citizen
or national after he or she fulfills the requirements established by Congress in the
Immigration and Nationality Act (INA).
Qualifications for Naturalization:
Having been a permanent resident for at least 5 years and meet all other eligibility
requirements
Having been a permanent resident for 3 years or more and meet all eligibility requirements
to file as a spouse of a U.S. citizen
Have qualifying service in the U.S. armed forces and meet all other eligibility requirements.
A child may qualify for naturalization if you are a U.S. citizen, the child was born outside the
U.S., the child is currently residing outside the U.S., and all other eligibility requirements are
met.
Note: A person may already be a U.S. citizen and not need to apply for naturalization if the
biological or adoptive parent(s) became a U.S. citizen before the individual reached the age of
18.
Resource: US Citizenship and Immigrations (http://www.uscis.gov/us-citizenship/citizenship-through-naturalization)
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